Andreas Vesalius, the Predecessor of Neurosurgery: How his ...€¦ · ideas of Galen of Pergamon...

Historical Vignette

Andreas Vesalius, the Predecessor of Neurosurgery: How his Progressive Scientific
Achievements Affected his Professional Life and Destiny
Bruno Splavski1-3, Kre�simir Rotim1,2, Goran Laki�cevi�c4, Andrew J. Gienapp5,6, Frederick A. Boop5-7,Kenan I. Arnautovi�c6,7

Andreas Vesalius, the father of modern anatomy and a predecessor of neuro-science, was a distinguished medical scholar and Renaissance figure of the 16thCentury Scientific Revolution. He challenged traditional anatomy by applyingempirical methods of cadaveric dissection to the study of the human body. Hisrevolutionary book, De Humani Corporis Fabrica, established anatomy as ascientific discipline that challenged conventional medical knowledge, but oftencaused controversy. Charles V, the Holy Roman Emperor and King of Spain towhom De Humani was dedicated, appointed Vesalius to his court. While inSpain, Vesalius’ work antagonized the academic establishment, current medicalknowledge, and ecclesial authority. Consequently, his methods were unac-ceptable to the academic and religious status quo, therefore, we believe that hisprofessional life—as well as his tragic death—was affected by the politicalstate of affairs that dominated 16th Century Europe. Ultimately, he went on apilgrimage to the Holy Land that jeopardized his life. While returning home, hisship was driven ashore on the Greek island of Zakynthos (Zante) where hebecame ill and suddenly died in 1564 at the age of 49. Vesalius’ ideas helped freemedicine from the limitations of the 16th Century and advanced scientificknowledge. His influence is still felt more than 500 years later. In this article, weacknowledge Vesalius’ neuroanatomic contributions and we discuss the his-torical facts and political circumstances that influenced his scientific careerand personal life, emphasizing the conditions of his pilgrimage to the Holy Landthat led to his untimely death.

Key words- 16th Century- Anatomy- Andreas Vesalius- Death- Neuroscience- Pilgrimage

From the 1Department of Neurosurgery, Sestre MilosrdniceUniversity Hospital Center, Zagreb, Croatia; 2OsijekUniversity School of Medicine, Osijek, Croatia; 3OsijekUniversity School of Dental Medicine and Health, Osijek,Croatia; 4Mostar University Hospital, Mostar, Bosnia andHerzegovina; 5Neuroscience Institute, Le Bonheur Children’sHospital, Memphis, Tennessee, USA; 6Semmes-MurpheyClinic, Memphis, Tennessee, USA; and 7Department ofNeurosurgery, University of Tennessee Health ScienceCenter, Memphis, Tennessee, USA

To whom correspondence should be addressed:Kenan I. Arnautovi�c, M.D., Ph.D.[E-mail: [email protected]]

Citation: World Neurosurg. (2019) 129:202-209.https://doi.org/10.1016/j.wneu.2019.06.008

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INTRODUCTION

“There are two ways of spreadinglight; to be the candle or the mirrorthat reflects it.”

—Edith Wharton, Vesalius in Zante.(1564)1

Andreas Vesalius (1514e1564) isconsidered a founder of modern medi-cine and a distinguished medical scholarand Renaissance figure of the 16th Cen-tury (Figure 1). He challenged andchanged the understanding of humananatomy by embracing empiricalscientific methods via cadavericdissections. His key scientific effort DeHumani Corporis Fabrica is not only aninnovative study of anatomy, but also a

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high-quality aesthetic and artistic work.The novelty and precision of his pio-neering findings and his inventivemethods to propagate these findingsthroughout the scientific communitywere indispensable, making Vesalius acentral and unique figure in the historyof medicine. He dared to challenge thestatus quo regarding research, teaching,and spreading scientific knowledge andin confronting dogmas of his contem-porary academic world.Many consider Vesalius also as a pre-

decessor of neuroscience because hisnumerous achievements included majorbreakthroughs in the understanding ofthe accurate morphology and func-tioning of the nervous system, whichlaid the groundwork for modern neuro-surgery as a separate scientific

WORLD NEUROSURGERY, http

discipline. His influence on medicalknowledge in general—as well as onneurologic surgery in particular—is stillrelevant today, more than 500 years later.Despite his significant contributions,

Vesalius was harshly opposed by hiscritics, which won him both ferventsupporters and fanatical foes. Hesubstituted traditional reliance on med-ical authority with observation andillustration, encouraging his studentsnot to rely on undisputed preexistingknowledge. He exposed and confrontedanatomic inconsistencies presented inGalen of Pergamon’s work and in thework of other eminent medical scholarsfrom antiquity.2-4 By doing this, hechallenged the academic establishmentand its entire body of medical knowl-edge. His critics believed his work

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Figure 1. Andreas Vesalius. Woodcut, 1543, after J.S. van Calcar (?). (Credit:Wellcome Collection. CC BY.)

HISTORICAL VIGNETTE

BRUNO SPLAVSKI ET AL. ANDREAS VESALIUS, LIFE AND DEATH

antagonized academic and ecclesial au-thority. Consequently, the controversycaused by his methods was unacceptableto both the academic and religious statusquo. Therefore, we believe that his pro-fessional life—as well as his tragicdeath—was affected by the political stateof affairs dominating 16th CenturyEurope. Ultimately, he took a pilgrimageto the Holy Land that ultimately jeopar-dized his life. His premature death hasinspired different hypotheses about whyit happened.Although the facts described earlier are

well-known, stemming from the exten-sive historical research, we believe thatsome of the more controversial details ofhis life and scientific career need to beaddressed in a slightly different scope.Besides, it is still not known why hedecided to take a pilgrimage to the HolyLand, what were the conditions of hisvoyage back home, as well as what

WORLD NEUROSURGERY 129: 202-209,

caused his premature death. Therefore,we consider it necessary to provide a newhistorical version of the controversialcircumstances leading to his tragicdemise, relying on the literature, whichremains sometimes divisive and debat-able, but also providing our own specu-lative explanation of the events in thelight of political and social environmentof the 16th Century.In this article, we discuss the historical

facts and political circumstances of Vesalius’time that influenced his scientific career andpersonal life. We also emphasize the con-ditions of his pilgrimage to the Holy Landthat led to his death, speculating that it wasnot a mere succession of unpredicted eventsonly. This article is also a tribute to Vesalius,honoring his accomplishments in estab-lishing human anatomy as a distinguishedscientific discipline and a prerequisite ofmodern medicine, neuroscience, andneurosurgery.

SEPTEMBER 2019 www.journals.el

THE BRIEF BIOGRAPHY OF ANDREASVESALIUS

Andreas Vesalius was born on December31, 1514 in Brussels, in what was then theHabsburg Netherlands—a geopoliticalentity consisting of the present-dayNetherlands, Belgium, Luxembourg, andnorthern France. He was the son of awealthy family of physicians and pharma-cists. Both his parental ancestors servedthe emperor of the Holy Roman Empire.5-7

Vesalius began his studies in 1529 at theUniversity of Louvain, Belgium, where helearned classical languages, rhetoric, phi-losophy and logic like most of his wealthycontemporaries.7 The university flourishedin the 16th Century because of thepresence of famous scholars andprofessors, such as Erasmus ofRotterdam (1466e1536), the great Dutchhumanist,8 who advocated an evangelicalpiety and questioned many of themedieval superstitions that had creptinto church philosophy.Afterward, Vesalius went to France in 1533

to studymedicine at the University of Paris tocomplete his medical degree.5 While there,he was a student of the famous Frenchanatomist Jacques Dubois (a.k.a. JacobusSylvius) (1478e1555), who was verycommitted to Galen’s ideas and consideredthem infallible.7,9-11 This position made thestudy of anatomy frustrating for Vesalius,motivating him to go to Paris cemeteries atnight in search of cadavers of his own todissect.5,7 Besides, the war between Franceand the Hapsburg Empire, of whichVesalius was a subject, hard-pressed him toleave Paris as a persona non grata.9

Finally, Vesalius went to the University ofPadua, Italy in 1537 to complete hisdoctorate, which was a flourishing environ-ment of medical humanism at thetime.4,12-14 The University was founded in1222, and was one of the oldest and mostprominent academic settings in early mod-ern Europe.12 After completing hisdoctorate, he was immediately appointed aProfessorship of Surgery at the age of 23because of his excellent performanceduring his studies.15-17 While holding thispost, he transformed anatomic classesentirely, improving them by performingcadaveric dissection, which was a rarepractice in the major medical universitiesof Medieval Europe.7,14,18 In addition, heencouraged direct communication with his

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HISTORICAL VIGNETTE


students to avoid being a strict andinaccessible authority figure.7 As aconsequence, he became morescientifically critical and promoted directobservation, abandoning the traditionalmedical curriculum established from theideas of Galen of Pergamon (AD 129ecirca200/circa 216).3,19 Galen was one of themost prominent Greek physicians duringthe Roman Empire, and establishedanimal dissection-based theories of humananatomy that dominated Western medicinefor more than 1300 years.15,17,20

Although Galen’s accomplishments inantiquity advanced medicine, he introducedsome incorrect theories and errors.4 Manyrenowned scholars fiercely defendedGalen’s ideas in opposition to Vesalius’methods.21 It appeared that thisantagonism may be one of the reasons whyVesalius left Padua in 1543 to be thepersonal physician to Emperor Charles V(1500e1558).15,16,22-24 Vesalius also servedCharles’ son and successor to the throne,King Philip II (1527e1598) for over 2decades.14 Apparently, Vesalius did notenjoy life in the Court.7,9 He sought to bereleased from royal service and left Spain in1564 to return to Padua, Italy to resume theteaching of anatomy following GarbrelleFallopio (1523e1562) who died fromtuberculosis.13,14,18,25 Fallopio was anotherprominent anatomist, who held Vesalius’previous Chairmanship of Anatomy.On his way back to Padua, he suddenly

decided to take a pilgrimage to Jerusalemand the Holy Land, possibly to reaffirm hisreligious adherence. However, the exactreasons for this voyage remain unknown.Unfortunately, Vesalius’ ship was unex-pectedly stopped on the Greek island ofZakynthos (Zante) when returning toVenice.25 He fell ill and died thereimmediately after landing on October 15,1564 at the age of just 49.25-27

Figure 2. Illustration of the death bed of Henry II of France, 1559. AmbroisePare and Vesalius are believed to be the 2 figures standing together at theend of the table. (Image in the public domain; reprinted from the NationalInstitutes of Health’s National Library of Medicine Digital Collection.)

VESALIUS AS A PHYSICIAN

After successfully completing De HumaniCorporis Fabrica, Vesalius went into medicalpractice, which was family tradition for 4generations.7,27-29 He accepted the posi-tion of the royal physician at the SpanishCourt in 1544, leaving his academic post inPadua.7 Over the next 20 years, he treatedbattle and tournament injuries asa military surgeon, as well as conductingpostmortem examinations and


administering medications toroyalty.13,28,30 Vesalius emphasized theimportance of understanding correctanatomic body structure during hispractice,17,28 insisting that surgery had tobe based on anatomy.17 In 1559, Vesaliuswas asked to give advice concerningmedical treatment of King Henri II ofFrance (1519e1559) who was fatallyinjured during a jousting tournament bya penetrating brain injury from asplintered wooden lance fragment(Figure 2).15,16,31-33 Together withAmbrois Paré (circa 1510e1590), themost celebrated surgeon of thecentury,2,34,35 Vesalius eventuallyproposed trephination that was nevercarried out. Vesalius also treated thebrain injury of Crown-Prince Don Carlosof Asturias (1545e1568) in 1562 when hefell down stairs and fractured his skull.13,36

Compared with other established med-ical disciplines, anatomy and surgery wereconsidered lower disciplines. As a result,Vesalius’more conservative and traditionalcolleagues did not appreciate his modernmethods, which they criticized and vigor-ously opposed.7,17,28

DE HUMANI CORPORIS FABRICA

Vesalius’ masterwork De Humani CorporisFabrica was published in Basel, Switzerlandin 1543, dedicated to the Emperor Charles


V, and established anatomy as a distinctiveevidence-based scientific disci-pline.15,16,27,28,37 Vesalius recognized theimportance of visualization and illustra-tion for anatomy education and used thesetechniques in groundbreaking ways.However, at the same time, the work wasalso a source of controversy and harshdebate because it threatened the academicand medical status quo.In hindsight, we can see that De Humani

Corporis Fabrica was one of the greatest con-tributions tomedical knowledge and scienceup to that time.37 It is one of the mostinfluential manuscripts on human anatomyand one of the remaining leadingbiological sources in the history of Westernscience.15,38 The work was comprised of 7volumes encompassing all organic systemsof the human body, which weremeticulously illustrated with woodcutengravings.23 The third volume covered thevasculature and circulation and included acomprehensive explanation of the arteriesand veins, including cerebral arteries andveins. The fourth volume of De HumaniCorporis Fabrica was dedicated entirely tonerves, whereas the seventh volumefocused on the brain itself and isconsidered the true foundation ofneuroscience.23,39 Almost certainly,Vesalius’ work was a fundamentalinspiration for anatomist William Harvey’s(1578e1657) masterpiece of blood

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HISTORICAL VIGNETTE


circulation De Motu Cordis, which appearedmore than 80 years later in 1628.37 It wasalso influential to the work of ThomasWillis (1621e1675), another greatanatomist of 17th Century, and a father ofmodern neuroscience.40,41

An abridged version of Vesalius’ workcalled De Humani Corporis Fabrica LibrorumEpitome was printed in 1543,30 and wasintended to be a concise and descriptivehandbook for students and surgeons. Thebook was dedicated to King Philip II ofSpain. The fifth chapter was concernedwith the brain and nervous system.17,24,26

The drawings in the Vesalius’ Fabrica aresome of the most famous medical figuresin the history of science because of theirpreviously unseen quality and precision.However, the identity of the illustratorswho produced the roughly 300 amazinglyaccurate images remained unknown.9,23

Some researchers have speculated thatVesalius’ drawings were associated withthe studio of a famous late-RenaissanceVenetian master painter Titian (1488/1490e1576).5,9,13,18,30,37,40 The illustrationsattracted immediate and enormous inter-est, particularly among medical pro-fessionals and among the renowned artistsof that time.17 The famous Renaissanceartist Michelangelo Buonarotti (1475e1564) allegedly planned a collaborationwith anatomist Realdo Colombo (1516e1559)—Vesalius’ colleague at theUniversity of Padua—to create a rivalbook of anatomic drawings to competewith Fabrica’s images.16 However, thiscollaboration never materialized, possiblydue to Michelangelo’s advanced age.Likewise, Leonardo da Vinci (1452e

1519) created numerous anatomic draw-ings, including those depicting the spinallordosis for the first time, but he wasunable to complete his objective of pro-ducing a systematic description of humananatomy because those drawingsremained unknown to a wider audience.42

Figure 3. Illustration of the cerebellum, brainstem, and cranial nerves from DeHumani Corporis Fabrica. (Image in the public domain; reprinted from theNational Institutes of Health’s National Library of Medicine Digital Collection.)

NEUROANATOMIC OBSERVATIONS

Vesalius was also the most innovativeneuroanatomist.30 His contributions to thefield of modern neuroscience were highlyvalued, although not acknowledgedenough.The seventh volume of the Fabrica and

the fifth chapter of the Epitome, wereconcentrated on the anatomy of the brain,


and included descriptions of the dura,skull, and cerebral vessels, as well as cra-nial, spinal, and peripheral nerves(Figures 3-5).16,17,30,40 These illustrationswere the first in anatomic history withpictorial accuracy.40 Vesalius also ridiculedand rejected Galen’s ventricular theory ofcognition in which mental functionswere thought to be contained within thecerebral ventricles.Vesalius’ findings added more accuracy

to the ventricular structures, which weremeticulously drawn and labeled in detail.However, his drawings of the cerebralhemispheres were short of key dis-tinguishing cortical features and did notreveal the gyral-sulcal pattern, as it isrecognized today.41

Although Vesalius did not consider thespinal column with its double curvaturequite as a single arch, he provided afunctional-anatomic idea of the lowerthoraco-lumbar spine, which remainedrelevant to a certain extent.42

The olfactory tract and bulb—mistak-enly not classified as a nerve—werenevertheless correctly described at thebase of the brain and facing the anterior


cranial fossa.30 In the second edition ofFabrica, the report on the effect of sectionof the recurrent nerve with consequentlaryngeal paralysis was included.30,39,43

POLITICAL CIRCUMSTANCES IN EUROPEIN 16TH CENTURY

Historians consider the 16th Century whenthe ascent of the West over the rest of theworld first began. This epoch of colo-nialism and trade established mercan-tilism as the principal economic theory ofthe day, which further modernized Europeand expanded its influence worldwide.However, it also simultaneously causednumerous power struggles within Europeitself.During the reign of Philip II of Spain,

who was a harsh enforcer of Catholicism,the Spanish empire reached the height ofits power, having conquered and colo-nized lands on every known continent.Meanwhile, in the Vatican, Pope Leo X

(1475e1521) was the leading Church au-thority and a patron of arts and learning.However, he did not take growing de-mands for church reform seriously,



Figure 4. Illustration of the brain and nervoussystem from De Humani Corporis Fabrica.(Image in the public domain; reprinted fromthe National Institutes of Health’s NationalLibrary of Medicine Digital Collection.)

HISTORICAL VIGNETTE


subsequently leading to the ProtestantReformation. The Reformation greatlydiminished the authority of the RomanCatholic Church and divided continentalEurope along religious lines. His succes-sor, Pope Clement VII (1478e1534),declined to invalidate the marriage of KingHenry VIII of England (1491e1547), whichinstigated the English Reformation andthe separation of the Church of Englandfrom papal authority. However, PopeClement VII also approved cadaveric


dissections, permitting anatomic studieson human bodies.44

Other great scientific breakthroughsdeveloped at this time that went againstthe status quo. Nicolas Copernicus (1473e1543)—another Padua Universityalumnus—proposed the theory of helio-centric universe. His book De RevolutionibusOrbium Coelestium published just before hisdeath in 1543 was a major landmark in thehistory of science and appeared the sameyear as Vesalius’ Fabrica. Both booksreceived similar critiques of the revolu-tionary concepts presented in each. Acontemporary of Copernicus, Pope Paul III(1468e1549) to whom Copernicus dedi-cated his book became the first Pope toconfront Protestantism, but his effortscreated more problems than solutions.One of the most momentous artistic worksof his reign was The Last Judgment fresco byMichelangelo, which decorates the altarwall of the Vatican’s Sistine Chapel andwas completed in 1541, 2 years beforeFabrica was published. The painting alsogenerated controversy because of its real-istic portrayal of the nude human body.At the same time, the Ottoman Empire

continued to expand and the OttomanSultan Suleiman the Magnificent (1494e1566) proclaimed himself Caliph. Heinitiated key legislative improvements insociety, education, science, art, taxation,and criminal law, and supported religioustolerance as well. Therefore, conflict withthe West was unavoidable.This was also a time of frequent pil-

grimages to the Holy Land. Medieval pil-grims of the Crusades who visited holysites experienced the perils of war andfaced a variety of other difficulties. Unlikethose who traveled to the Holy Land toreclaim it for Christendom, the subse-quent pilgrims of the Renaissance weremostly motivated by religious piety and/orthe need to apologize personal sins.45

They were not warriors and soldiers, butmainly the nobility or wealthy seekingsome kind of atonement.Nonetheless, the age of the Renaissance

brought abundant intellectual change toall of society by modernizing society andencouraging critical thinking. The medie-val world retreated slowly but steadily,which enabled the eventual rise of a noveland progressively more rational philoso-phy founded in the arts, literature, sci-ence, and medicine to some extent.


Universal human values, as well as bodymorphology, took center stage and wereobserved and researched thoroughly foraesthetic, anatomic, and functionalfeatures.The introduction of the printing press

by Johannes Gutenberg (1400e1468) in1439 in Mainz, Germany, entirely trans-formed book publishing, and the dissem-ination of information to broaderaudiences. Books, which were once scarceand few and were cautiously cared for inrare libraries, quickly became abundantand widely available. However, the Churchand most European governments duringthe 16th Century attempted to controlprinting, which permitted widespread andquick transmission of information andideas.The broad-based combination of the

scientific approach, innovative teaching,and publishing made achievable duringthe Renaissance was found mostlythroughout the university environment ofthe Italian city-states, including the city ofPadua, part of Venetian Republic. TheItalian city-states managed to keep strictChurch control and imperial power at bay,creating an optimal foundation for socialand economic progress, and for majorintellectual and artistic changes.12,46,47

Besides all conflicts and controversies ofthe 16th Century, which threatened the veryexistence of prominent scientists, includingVesalius himself, it was still a time ofmultifocal improvement of every aspect oflife, particularly for art and science. Ac-cording to Francis Bacon (1561e1626), theEnglish philosopher and advocate of thescientific method, the aim of modern sci-ence—after being removed from previousmetaphysical assumptions—should befocused on empirical observation, realexperience, and experimentation.48 Apartfrom being idealistic, and despitenumerous obstacles to progress, it wouldbe Vesalius’ legacy as well.

MEDICINE IN 16TH CENTURY EUROPE

During the Middle Ages, the Churchcontrolled all aspects of life, including thepractice ofmedicine.22 At the turn of the 15thto 16th Century, Galen’s ideas and conceptsstill dominated medicine and were thoughtto be infallible.19 Diseases were believed tobe initiated by body disturbances, mirroringan inner harmonious imbalance. Prevalent

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Figure 5. Illustrations of the brain from De Humani CorporisFabrica. (A) Brain with dura mater intact. (B) Exposed brain withdura mater peeled away. (C) Cross-section of brain revealing the

ventricles and choroid plexus. (Images in the public domain;reprinted from the National Institutes of Health’s National Libraryof Medicine Digital Collection.)

HISTORICAL VIGNETTE


general methods for restoring physicalbalance included bleeding, cupping, andpurging, administered by barber-surgeonswho were often illiterate medical practi-tioners with no formal education.2,22

Bleeding was a dangerous procedurebecause of the lack of anatomic knowledgeand the increased risk of infection. Never-theless, it was used randomly for all kinds ofailments. To execute bleeding, leeches werecommonly used.

Figure 6. Location of the island of Zakynthos in relatiopublic domain; adapted from Wikipedia: https://commSea_location_map_(blank)_2.svg.)


Before Vesalius’ time, anatomy andsurgery were underdeveloped comparedwith other medical disciplines. Surgerywas still nascent, consisting of woundmanagement and crude limb amputationsperformed by barber-surgeons.22 Humanbody dissections were not common inEurope, apart from some Italian city-staterepublics and largest Spanish cities.46,49

Subsequently, medicine of that timemainly remained stagnant.

n to the Greek mainland (circled). (Image in theons.wikimedia.org/wiki/File:Mediterranean_


The first formal anatomists of antiquitywere Herophilus (335e280 BC) and Era-sistratus (304e250 BC),16,28 both of whomhad emerged in Hellenist Alexandriaapproximately 300 BC.4,49 Both menestablished the use of cadaveric dissec-tions for anatomic medical study.50 It isgenerally accepted that human anatomicdissections were nonexistent during theMiddle Ages. However, they reemergedin medieval Italy at the beginning of the14th Century.49-51 The University ofBologna was the earliest place of thisrevival.7 Mondino de Luzzi (1270e1326)introduced human cadaveric dissection inBologna in 1315,9,20,49 and published thefirst practical manual of anatomy, theAnathomia in 1316.20 It became theprimary medieval neuroanatomic text aswell, describing meninges and cerebralventricles responsible for fantasy,memory, and cognition.47,51 However,Mondino’s central philosophy was toconfirm Galenic writings rather thandiffer from them.9,51

Nevertheless, dissections remained alimited practice until the Renaissancewhen such a procedure became lessrestricted. Dissections were then routinelyintroduced into many medical universitiesas an important tool for developing aca-demic medical knowledge.44,49

Throughout the 16th Century, the prac-tice of anatomic dissection was alsoconsolidated in Spain.46

Prior to Vesalius’ work, Guido da Vig-evano (1280-1349), Mondino’s successorwho wrote the first anatomic atlas,49,51 andBerengario de Carpi (1460-1530), both the


https://commons.wikimedia.org/wiki/File:Mediterranean_Sea_location_map_(blank)_2.svg

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HISTORICAL VIGNETTE


anatomists from the University ofBologna, began to modernize the disci-pline.9 Bernegario made a number ofentirely novel anatomic observations,51

and he was the first one notoverwhelmed by earlier authorities.7 Healso contributed considerably to brainanatomy, providing detailed descriptionof the meninges and cranial nerves, aswell the ventricular system, includingchoroid plexuses, interventricularforamen, infundibulum, and pituitarystalk and gland.Both Leonardo Da Vinci and Michel-

angelo produced detailed anatomic draw-ings based on cadaveric humandissections, but they remained unknownto the academic world. All of that hadcreated the basis and inspiration forVesalius’ milestone work.Consequently, this new understanding

of human anatomy allowed surgery toemerge as a more prosperous field andaffirmed the importance of surgeons likeAmbroise Paré, Vesalius’ contemporaryand a strong supporter who is consideredthe “father of modern surgery.”2,34,35

THE PILGRIMAGE AND PREMATUREDEATH

The prevailing Christian doctrine duringthe Middle Ages and beyond emphasizedthe soul but not the body in which it wascontained.51 Therefore, we suppose thatVesalius antagonized religious andpolitical authorities by his methods, hisrevolutionary ideas, and the content ofhis scientific works.There are a few theories of Vesalius’

final days that attempt to explain the rea-sons for his sudden departure to the HolyLand. Vesalius’ prominent biographeradvocated that he used the pilgrimage as aprerequisite to leave the Spanish Courtand to reclaim his professorship at PaduaUniversity.7,14 Another theory suggestedthat Vesalius was accused to had per-formed dissection on a Spanish aristocratwhen the heart was still beating, and wasordered to take a pilgrimage as penancefor this sinful act.52 A different sourcestated that Vesalius had been severely illand decided to take a pilgrimage out ofgratefulness for his recovery.13 Modernscholars suggest that Vesalius did notleave the Court for his pilgrimage toJerusalem under pressure, but that he left


on his own with the full support of theKing Philip II who provided him withintroduction letters to Spanish embassiesabroad.53

It is surprising that the reasons for hispilgrimage are so contradicting, bearing inmind how renowned and famous Vesaliuswas. Nonetheless, we hypothesized thathe took the mandatory pilgrimage to Je-rusalem to endorse his obedience to po-litical and ecclesial authorities.Considering the society’s prevailing con-servativism, and political background ofthe events precipitating the journey, thisseems the most plausible explanation tous, although some respectful Vesalius’biographers stated otherwise.7,52

During his stay in Jerusalem, itappeared that Vesalius was more con-cerned with local botany than the piousdoings of a pilgrim.13 After a few monthsstay in the Holy Land, Vesaliusapparently embarked on an inadequateill-equipped vessel with the limited stor-age of food and water supplies on his re-turn voyage.13 Possibly, his allegedpersonal parsimony was blamable forchoosing such a humble ship offeringbad traveling conditions.14 Finally, hisship was stopped on the Greek island ofZakynthos (Zante) in the Ionian Sea (apossession of the Venetian Republic),where the completely exhausted andsickened Vesalius was put ashore alone(Figure 6).13,14,26 He died shortlythereafter, probably from a contagiousdisease or fatigue because of the ship’spoor settings. The most plausibleexplanation of his death seems to beillness, possibly exacerbated by generalweakness.25,54

CONCLUSIONS

This historical vignette discusses condi-tions and events associated with the lifeand final pilgrimage leading to the tragicdeath of Andreas Vesalius, who intro-duced a revolutionary concept of anatomicteaching based on human cadavericdissection, observation, and illustrations.His ideas and methods helped to advancemedicine well beyond the limits of the16th Century. He first understood theimportance of learning through one’s ownexperience and how this understandingcould aid in the acquisition of newknowledge. At the same time, he created


an anatomic textbook, a masterpiece thatis considered the most important biolog-ical manuscript in the history of Westernscience. His impact on modern neurosci-ence was exquisite as well. However, hislife and destiny were burdened by politicalcircumstances and the social conservatismof that time, which supposedly contrib-uted to his tragic death.

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Conflict of interest statement: The authors declare that thearticle content was composed in the absence of anycommercial or financial relationships that could be construedas a potential conflict of interest.

A brief version of this article has been presented as a PosterPresentation at the 2018 American Association ofNeurological Surgeons (AANS) Annual Meeting in NewOrleans and earned a Second Place award.

Received 7 February 2019; accepted 5 June 2019

Citation: World Neurosurg. (2019) 129:202-209.https://doi.org/10.1016/j.wneu.2019.06.008

Journal homepage: www.journals.elsevier.com/world-neurosurgery

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